CHAPTER SIX

(Im-)Potent Knowledges.
Preserving ‘Traditional’ Tibetan
Medicine Through Modern Science1
STEPHAN KLOOS

When we lose the potency of tradition, then we need the help of modernity.
Dr. Tenzin Thaye, September 19, 2008, Dharamsala

Tibet is widely associated with the tragic story of occupation, exile, and loss that
began with Mao’s invasion of Eastern Tibet in 1950, culminated with the Dalai
Lama’s flight to India and the violent reforms of the Cultural Revolution, and
continues today amid media reports on human rights abuses, self-immolations,
and rapid modernization in Tibet.2 In many ways, Tibet’s fate is one seen all too
often in world history. What makes it stand out, however, is the Dalai Lama’s
successful portrayal of Tibetan culture as a rich repository of knowledge holding
unique relevance for the contemporary world (see e.g., Dalai Lama, Ancient Wis-
dom). This characterization, and the related concern with cultural survival, taps
into a more general, global modernist narrative (Adams, Particularizing Moder-
nity 222) that assigns ‘traditional’ knowledge a precarious status of weakness,
defined by the specter of imminent loss and the imperative for preservation. Two
kinds of knowledge in particular function as central identifiers of Tibetan cul-
ture: the spiritual-philosophical knowledge of Tibetan Buddhism, and the medi-
cal-pharmaceutical knowledge of Tibetan medicine, also known as Sowa Rigpa
(gso ba rig pa: the science of healing). This essay will explore Tibetan efforts to

1 I would like to express my gratitude to the organizers of the symposium “Fugitive Knowl-
edges” at Rostock University for inviting me to participate in this exceptionally productive
opportunity for intellectual exchange – particularly Gesa Mackenthun, Klaus Hock, Hans-
Uwe Lammel, and all the involved graduate students. I am also indebted to Andreas Beer
for his careful editing and constructive comments, and to Paula Ross for her excellent
English language improvements; needless to say, any remaining errors are mine alone. The
research and writing of this chapter has been funded, at different stages, by the Wenner
Gren Foundation, the Austrian Science Fund (FWF P25997–G15), and an ERC Starting
Grant (336932). As usual, this work would not have been possible without the help and
cooperation of the practitioners and administrators of Tibetan medicine in India. I thank
them all.
2 See Powers for a good collection of references on both the Chinese and exile Tibetan
positions.

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124 | Stephan Kloos

engage with modern science in order to ‘preserve’ Tibetan medicine in a context

of exile, modernity, and a capitalist economy.

Tibetan (Medical) Knowledge in Exile

Together with Buddhism, Tibetan medicine came under direct attack by Mao’s
armed troops during the 1950s, especially after the failed Lhasa uprising in March
1959, when China forcibly annexed Tibet and implemented radical Communist
reforms. The most prestigious Tibetan medical institution until then – the Chag-
pori Drophen Ling in Lhasa – was bombed and leveled, as were most other med-
ical and monastic establishments during the following decade. Similarly, innu-
merable medical and religious scriptures were destroyed, and large numbers of
doctors and monks were killed and imprisoned. In the words of one medical
anthropologist and historian, “by 1973 Tibetan medicine as an institution had vir-
tually disappeared” in Tibet (Janes, “Transformations” 20). Meanwhile, the Dalai
Lama and some eighty thousand Tibetans had fled across the Himalayas to India
– a passage that proved to be a veritable bottleneck through which only a fraction
of Tibet’s medical knowledge, in the form of a handful of doctors and whatever
texts they managed to carry, passed into exile. Both in Tibet and in exile, Tibetan
medicine was therefore confronted with an unprecedented loss of knowledge held
by experts, texts, training facilities, institutional structures, and the very plural-
ity of local experience. Tibetan medical knowledge thus became fugitive in a geo-
graphical, political, and epistemological sense, and was reinscribed in a register
of cultural loss and preservation.
This was an entirely new situation for Tibetan medicine, which – like Bud-
dhism – constituted not only one of Tibet’s five major sciences, enjoying a high
level of prestige and social status, but also served as a hegemonic institution
through which the Central Tibetan state had pursued its political agenda (Schaef-
fer; Garrett). As such, it had been well organized through a network of powerful
medical centers, a large and complex canon of authoritative texts, and a lively tra-
dition of scholarship and debate. Until 1959, Tibetan medicine enjoyed a quasi
monopoly on professional, pharmaceutical-based healthcare in Tibet, was widely
known beyond Tibet’s borders for its efficacy and sophistication, and attracted
both students and high-ranking patients from throughout Central Asia. In short,
Tibetan medicine and Buddhism strongly informed Tibet’s cultural and political
identity as a powerful civilization, with its systematic destruction by the Chinese
striking a serious blow against the Tibetan nation.
From the very beginning, the Dalai Lama and his government-in-exile thus
framed the loss of religious and medical knowledge within a discourse of cultural
survival. This discourse found resonance not only in the international sphere (see
Lopez; Dodin/Räther) but also among the Tibetan exile community, which began
to focus its efforts – individual, institutional, and policy – on the preservation of

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 (Im-)Potent Knowledges | 125

what it considered ‘Tibetan culture’, that is, a national identity revolving around
the Mahayana Buddhist ethics of altruism and compassion (see Kloos, Tibetan
Medicine). This was particularly true for Tibetan medicine, which found itself
responsible for ensuring not only the physical survival of sick Tibetan refugees,
but also the cultural survival of the Tibetan nation. Tibetan medicine, owing to
this crucial dual role and traditional status as one of Tibet’s major sciences, soon
came to be seen as a prime symbol and placeholder of the Tibetan culture it was
meant to preserve. The preservation and potential loss of its own medical knowl-
edge was thus crucial to – and to some extent even synonymous with – the pres-
ervation and loss of Tibetan ethics and culture at large, and consequently became
the central and defining purpose of Tibetan medicine in exile.
In the 1960s, it had already become clear to the Dalai Lama that an engage-
ment with modern science was key to the preservation of both Tibetan medi-
cine and culture. Thus, in his speeches on the topic of Tibetan medicine from
1969 up to the present (compiled in Dalai Lama, Srid zhi’i), he has consist-
ently exhorted its practitioners – also known as amchi – to “combine Western
and Tibetan medicine,” to be “broad minded” (1978) and “compliant with modern
times and current practices” (1982), to “seek the expertise and advice of modern
medical science” (1987), “to tread the path of science” (1994), to “make inno-
vative discoveries” (1995), “to research and evaluate Tibetan medicine through
the prism of modern science” (1998), to “take the best bits of Western medical
practices and create a fine blend” (2000), and to learn how “to explain Tibetan
medicine in terms of Western medicine” (2006). Given the difficulties involved
in reestablishing Tibetan medicine from scratch during the first decades in exile,
it was not until the 1980s that its premier institution, the Dharamsala-based
Men-Tsee-Khang, was in a position to heed the Dalai Lama’s advice. Even then,
the task of conducting research was daunting for the Men-Tsee-Khang, whose
doctors and staff lacked even the most rudimentary scientific training, and openly
questioned the necessity of ‘proving’ their medicine by modern means.
Today, the exile Tibetan amchi’s perception of modern science has changed
dramatically: modern science is – however reluctantly in some quarters –
regarded as playing an essential role in the ‘preservation’ of Tibetan medicine and
its knowledge. While the Men-Tsee-Khang occupies a leadership position in this
regard – due mostly to its superior human and financial resources and its direct
affiliation with the Dalai Lama – this perception is shared by virtually all practi-
tioners of Tibetan medicine in South Asia and the West today, regardless of their
institutional affiliation.3 As one doctor told me, “It’s about the survival of Tibetan

3 There are four official Tibetan medical institutions operating in exile today, all of them
located in North India: the Men-Tsee-Khang in Dharamsala, the medical faculty at the
Central University for Tibetan Studies (CUTS) in Sarnath, the Chagpori Tibetan Medical
Institute in Darjeeling, and the medical faculty at the Central Institute for Buddhist Studies
in Choglamsar, Ladakh. So far, other than the Men-Tsee-Khang, only the medical faculty
at CUTS has conducted small-scale clinical research. This is also the reason for the heavy
reliance on interviews with Men-Tsee-Khang doctors in this essay. However, there are also

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126 | Stephan Kloos

medicine in an age of science and skepticism. If we don’t prove Tibetan medicine

scientifically, people – even Tibetans – will stop taking it, and this great treasure
of knowledge will get lost” (Dr. Tseten Mingyur, June 25, 2006, Dharamsala).4
Another doctor added: “We don’t have any doubts about our medicines. But now-
adays, people are very intelligent. They want proof, documentation; they need
paper!” (Dr. Jamyang Tashi, July 18, 2005, Kalimpong). What modern science
could provide, then, was the gift of visibility, which could make Tibetan med-
icine not only acceptable and ‘legible’ (see Scott 9–83), but even attractive to
those who needed proof in order to consider something scientifically valid. This,
in turn, made modern science attractive to Tibetan amchi, who hoped to learn the
art of making their knowledge, ethics, and culture appreciable by the world. In
the words of Dr. Tenzin Nyima: “Modern science is like an ornament for tradi-
tional knowledge” (September 3, 2008, Dharamsala).
Consider this: dislocated from its usual position of superiority to a place
within the Tibetans’ own Buddhist epistemic framework, modern science is rein-
terpreted as an ornament (rgyan) to enhance the outward appearance of Tibetan
knowledge without changing its inner substance; as a tool to instill faith in non-
believers and thereby achieve international recognition, ensuring the long-term
survival of Tibetan medicine. This is a far cry from science’s own self-definition
as a rational arbiter of truth vis-à-vis supposedly irrational phenomena like spirit-
uality, faith, or belief. It is, however, completely in line with the amchi’s overall
goal of enlisting modernity in order to translate and incorporate it into the frame-
work of their own postcolonial national culture. Stated in medical terms, in order
to cure Tibetan medicine and culture, which were simultaneously threatened by
modernity and suffered from a lack thereof, they transformed the potent but dan-
gerous substance of modern science into an ‘elixir of health and rejuvenation’.
Modern science here is clearly associated with modernity and Tibetan med-
icine with tradition. But in contrast to modern science’s hegemonic discourse
that monopolizes truth and dismisses ‘traditional’ forms of knowledge as mere
‘beliefs’ (Good; Pigg), exile Tibetan amchi see their medical tradition as an alter-
native science that is at least as valid – and valuable – as modernity’s science.
Regarding the two kinds of knowledge – traditional and modern – not as neces-
sarily conflicting opposites but as mutually complementary sciences, amchi aim
to engage with modernity on their own, Tibetan, terms. These involve ‘taming’
or ‘subduing’ the Other in order to incorporate it into a Tibetan (Buddhist) epis-
temic framework and use it for the Tibetans’ purposes, as in the well-established
Tibetan Buddhist figure of the ornament. While acknowledging the importance of
engaging with modern science, most exile Tibetan amchi are convinced that this
is first and foremost a political rather than a scientific requirement. As Dr. Tenzin

individual Tibetan amchi and experts who have been centrally involved in modern research
on Tibetan medicine (see, e.g., Aschoff/Tashigang; Choedon et al.) – not counting the larger
field of textual and literary research.
4 All interviews excerpted in this essay were conducted by the author.

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 (Im-)Potent Knowledges | 127

Namdul from the Men-Tsee-Khang’s Clinical Research Department said in a lec-

ture on the topic (April 19, 2008, Dharamsala):

When we go to conferences and so on, we always encounter a lot of

skepticism and doubt about Tibetan medicine: “How can you guys say
that Tibetan medicine can be effective for diabetes or cancer?” At the
end of the day, the big question is always whether we have done any
scientific clinical studies, whether our medical system has been recog-
nized by any government. […] One thing I always try to tell these peo-
ple – even our own doctors and students here – is that we need to look
back in history. Tibetan medicine has made important advances through
research and development. So we actually need to have a bit more confi-
dence and realize that we already have the foundation.
If you look into the texts, the compounding of medicines, the practice,
everything: without in-depth research in early times we would not have
what we are seeing now. So they have done research. Today the big
challenge for us is to do research that employs the Western scientific
system. This is difficult, and in a way it’s improper to try to insert the
Western scientific approach into Tibetan medicine. So we need to see
how we can do it, making sure that we keep the Tibetan medical tradi-
tion intact but are also able to do evidence-based research studies.

Indeed, Tibetan doctors in exile have been involved in a number of clinical stud-
ies, especially since the late 1990s. For example, between the late 1980s and
2010, the Men-Tsee-Khang’s Clinical Research Department conducted ten clinical
and three laboratory-based studies, including studies on cancer, diabetes, rheuma-
toid arthritis, and hypertension. Not only Tibetan amchi, but also Western schol-
ars interested in the encounter between Tibetan medicine and modern science
have focused mostly on such clinical studies, especially in the Tibetan Autono-
mous Region (TAR) and adjacent areas in China (see the works by Adams; Janes;
and Craig). In this essay, however, I will shift the focus both geographically, to
the underexplored context of Tibetan medicine in exile (that is, to India), and the-
matically, away from clinical trials to a much more fundamental aspect of Tibetan
medicine’s encounter with modern science: modern quality control. Hardly dis-
cussed and barely apparent to anyone but the most involved amchi, this effort to
ensure, through modern means, a certain level and standard of quality and effi-
cacy in the production of Tibetan medicines does not fit the ornament metaphor,
but rather that of a silent revolution. As Tsewang Gyatso, a biologist who worked
at the Men-Tsee-Khang’s Materia Medica department until 2009, told me, “Actu-
ally, although everybody talks of research, our priority is the quality control of
the medicines and raw materials” (December 31, 2007, Dharamsala).

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128 | Stephan Kloos

Quality Control and the Problem of Efficacy

In 1997, the Men-Tsee-Khang initiated a clinical trial on diabetes mellitus in

cooperation with the All India Institute for Medical Sciences (AIIMS) in New
Delhi, one of India’s most prestigious medical institutions. This clinical trial
was a breakthrough for the Men-Tsee-Khang in several ways: it was the first
study yielding results that were not only promising but also statistically conclu-
sive enough to be published as a letter of observation in the American Diabe-
tes Association’s journal Diabetes Care (see Namdul et al.). It also strengthened
the Men-Tsee-Khang’s relations with the AIIMS, whose doctors were enthusiastic
about the results, and marked the beginning of modern quality control and efforts
to standardize Tibetan medicines. While the study’s success resulted in admin-
istrative limits on Tibetan medicine’s engagement with science,5 its shortcom-
ings unexpectedly set in motion a process that would change Tibetan medicine
more profoundly than clinical studies ever could. For the main problem that arose
during the diabetes study was not one of research design or statistical validity
– issues that had failed to attract the Men-Tsee-Khang administration’s attention
before – but one that concerned Tibetan medicine’s efficacy. During the study,
patients who initially responded well to the Tibetan pills complained that sud-
denly the same drug did not seem to work anymore. The amchi’s traditional diag-
noses using data derived from pulse diagnosis, urine analysis, and patient inter-
views concurred with these complaints, and were confirmed by the same biomed-
ical tests that had previously demonstrated the Tibetan pills’ efficacy. For the first
time, Men-Tsee-Khang doctors were confronted with hard evidence that the effi-
cacy of their medicines varied from batch to batch. It became clear that the stand-
ardization of their medicines was imperative, both for the sake of future clinical
trials and out of responsibility toward their patients.
What should we think of this? Has the efficacy of Tibetan medicine always
been unpredictable, has it always lacked adequate procedures of standardization
and quality control, deficiencies that have only now come to light thanks to phar-
maceutical mass production and modern science? To some extent, perhaps. It is
true that traditionally there was no such thing as ‘quality control’ in the sense of
a single, clearly defined process, although amchi can and do check their medi-
cines’ quality and efficacy by taste, sight, smell, and patient diagnosis. Rather,
the quality of Tibetan medicine depended on the amchi’s ethics – one could say,
their character and motivation – which translated into how diligently they fol-
lowed the prescribed methods of identifying, collecting, drying, cleaning, stor-

5 The Men-Tsee-Khang’s administration at the time failed to understand the scientific

results of the study and was unprepared for the enthusiasm these results created among
the involved Indian biomedical researchers. According to one informant, the consequent
decision to block any follow-up studies reflected the general fear of cultural dispossession
and suspicions against ‘overly interested’ foreigners then prevalent among sections of the
Tibetan exile society.

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 (Im-)Potent Knowledges | 129

ing, and compounding their ingredients. These methods are clearly explained
in classical Tibetan medical texts, such as the seventeenth-century Shel gong
shel phreng by Deumar Geshe Tenzin Phuntsog (Deumar; see also Ridrag, and
Men-Tsee-Khang), which also describe eight types of potency (nus pa) and their
characteristics. Far from being confined to the mere examination of ingredients
by taste, sight, and smell, this kind of ‘quality control’ thus formed the funda-
mental basis – and provided clear standards – for Tibetan pharmaceutical pro-
duction. In the words of Dr. Tsewang Tamdin who at different times headed the
Men-Tsee-Khang’s pharmaceutical department, college, and the entire institute as
its director: “You could say that being ethical, being Buddhist, is the best quality
control” (May 27, 2008, Dharamsala).
Certainly, these traditional methods of standardization and quality control
never were – or needed to be – as accurate as modern technologies promise to
be. But there is no doubt that they worked well enough for Tibetan medicine
to become renowned in large parts of Asia during the past centuries and, lately,
around the world. There is also no doubt that even today, the Men-Tsee-Khang
takes its traditional methods of standardization, as well as its Buddhist ethical
ideals and practices with regard to medicine production, extremely seriously. If
neither the traditional methods of quality control and standardization per se, nor
their lack of implementation could be blamed for the fluctuating results of the
pills prescribed by Men-Tsee-Khang practitioners, then what was the problem?
And why did the Men-Tsee-Khang end up embracing modern quality control?
To begin to answer these questions, it is necessary to consider the importance
of modernity for nationalist struggles like that of Tibet. As mentioned above,
Tibetan medicine’s main purpose in exile was not so much to cure individual
patients – although that was what it did on a day-to-day basis – but rather to heal
an ailing Tibetan culture and nation. However, if Tibetan medicine in fact embod-
ied and represented that culture, then, according to this logic, it was sick itself –
something easily confirmed by a historical glance at its desperate conditions dur-
ing the 1960s and 1970s (see Kloos, “History and Development”). This meant, in
turn, that its traditional formulas alone were incapable of healing that culture or
the Tibetan nation, and that it therefore needed to look elsewhere for help. Enter
modernity, and with it, science. In Gyan Prakash’s words, “science has always
been asked to accomplish a great deal – to authorize an enormous leap into
modernity, and anchor the entire edifice of modern culture, identity, politics, and
economy” (Prakash 12). Indeed, the crucial element the Tibetans lacked, but that
was indispensable in their quest for cultural and national survival – and hence
the preservation of their ‘traditions’ – was modernity. We have thus returned to
the opening statement of Dr. Tenzin Thaye from the Men-Tsee-Khang’s Pharmacy
Department, who was later appointed Visiting Physician to His Holiness the Dalai
Lama: “When we lose the potency of tradition, then we need the help of moder-
nity.”

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130 | Stephan Kloos

Almost from its inception, Tibetan medicine in exile has undergone a gradual
modernization process. Initially, this was due to the current Dalai Lama’s personal
initiative to reform and modernize Tibetan society as a whole and Tibetan med-
icine in particular – something his predecessor, the Thirteenth Dalai Lama, had
already tried but largely failed to do (see Van Vleet; Choelo Thar 3–41; Gold-
stein). The condition of exile, however catastrophic otherwise, proved to be a fer-
tile ground for the Fourteenth Dalai Lama to implement his visions of reform.
Thus, in the 1960s, the reestablished Men-Tsee-Khang in Dharamsala was not
structured like a monastic community (as its mother institution, the old Lhasa
Mentsikhang, had been until 1959), but as a modern secular college and gov-
ernmental health center, training predominantly lay students – including women
– and in the beginning providing free, and then later inexpensive health care to
the public. In the late 1960s, earlier than its counterpart in Lhasa, it mechanized
pharmaceutical production, and during the 1970s adopted a capitalist business
model and started generating profits, which it reinvested in Tibetan medicine’s
further development. By the 1980s, however, the Men-Tsee-Khang’s sheer suc-
cess, and Tibetan medicine’s increasing importance to the exile Tibetan politi-
cal cause, overtook the Dalai Lama’s initiative as the main force behind modern-
ization. Entering nationalist politics and the capitalist market, Tibetan medicine
was called upon to modernize not only in material terms, for example, through
the purchasing of new machinery, but also as an institution representing Tibetan
knowledge, ethics, and culture. In other words, the more Tibetan medicine was
forced to modernize in order to fulfill its role in advancing the Tibetan cause,
the more it came, by virtue of its success, to represent an assumed ‘traditional’
exile Tibetan political and cultural identity. To mobilize the world on the side
of the Tibetan political struggle, Tibetan medicine needed to acquire financial
resources, secure solid legal status as well as scientific validity, and earn the faith
of its own people. That is, it had to remake itself as a modern alternative health
resource while at the same time remaining ‘traditional’ and uniquely Tibetan. Two
of the solutions comprised dressing Tibetan medicine in modern garb with the
help of clinical trials, and to providing modern packaging for its pharmaceuti-
cals (see Kloos, “Navigating”). Others included transforming Tibetan medicine
into a clearly defined ‘medical system’ – partly with the help of science – that
could be regulated, standardized, and legally recognized (see Kloos, “Medical
System”). Most importantly, however, its practice needed to ensure the reliability
of its treatments in a modern context, for which, as we will see, modern means
proved necessary. In other words, the most central domain in which tradition and
modernity met, and needed to be negotiated, was that of efficacy.
There is a good reason for this. Most patients care or know little about
Tibetan medicine’s status as a symbol for Tibetan culture and civilization, much
less its power to heal the Tibetan nation. What they do care about is its medical
potency, its ability to cure their immediate physical or mental ailments. For all
their nationalism, faith, and religiosity, Tibetans in exile are eminently pragmatic.

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 (Im-)Potent Knowledges | 131

Like anyone faced with pain and suffering, they judge a medicine by whether
and how it works: no matter how ‘Tibetan’ it might be, treatment is useless if
it does not remedy their diseases. Tibetan medicine’s popularity and dissemina-
tion thus strongly depend on its medical efficacy, as evidenced by the spread of
Men-Tsee-Khang branch clinics in urban India, which is largely driven by local
demand and sponsorship in the wake of news of spectacular cures.6 Efficacy is the
indicator of Tibetan medicine’s soundness and strength, and it is also crucial to
the extent that doctors consider it the true locus of their practice’s identity, its tra-
ditional Tibetanness. Ultimately, the preservation of Tibetan medicine is nothing
but the preservation of its efficacy. As a consequence, when the Men-Tsee-Khang
discovered that the medical efficacy of its pills fluctuated, despite its best efforts
to ensure their quality and potency through traditional means, those findings pre-
sented a serious challenge: at stake was not merely the health of a few individu-
als or the success of a clinical trial, but Tibetan medicine and culture themselves.

The Impotence of Tradition

Given the strong connection between Tibetan medicine’s clinical efficacy on the
one hand, and its cultural and political efficacy on the other (see Kloos, “Alche-
mie”), it is not surprising that the otherwise conservative Men-Tsee-Khang
administration decided to introduce into its pharmaceutical unit, at considerable
cost and against the objections of several senior amchi, modern quality control
technologies. But we are still left with the question of why the traditional meth-
ods of quality control no longer worked. For this, let us return once more to Ten-
zin Thaye’s statement: “When we lose the potency of tradition, then we need the
help of modernity.” Most obviously, what Tenzin Thaye meant by ‘tradition’ is
Tibetan medicine, the potency and efficacy of which is in danger of being lost.
As he explained why this was so, he quickly arrived at the issue of quality con-
trol: the efficacy of Tibetan medicine is lost when traditional methods of quality
control lose their ability to ensure the potency of the ingredients. Furthermore, as
described above, traditional quality control is strongly connected to Buddhist eth-
ics. ‘Tradition’ in Tenzin Thaye’s statement thus not only refers to Tibetan med-
icine, nor just to specific processes that we might today call ‘traditional quality
control’. At the deepest level, ‘tradition’ for Tenzin Thaye means Tibetan Bud-
dhist ethics, with altruism and compassion at its core.

6 For example, the Navi Mumbai branch clinic was opened after Men-Tsee-Khang doctors
cured a boy with terminal lymphoplastic leukemia. The Chennai branch clinic was opened
after the successful treatment of metastatic lymph cancer in a retired Indian army colonel.
There are similar stories behind the Men-Tsee-Khang’s Ahmedabad branch clinic and
several others, while the New Delhi branch thrives on its reputation of achieving positive
results in the treatment of asthma, diabetes, and other conditions.

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132 | Stephan Kloos

This has been confirmed repeatedly by other exile Tibetan amchi, like Dr.
Tsering Wangdue, who told me: “What is tradition, after all? Tradition is basi-
cally compassion, it’s the motivation. If we lose our tradition, it means we lose
our compassion, and then we have lost the most important thing” (June 24, 2008,
Dharamsala). Indeed, not just the term ‘tradition’, but Tibetan identity and culture
as a whole are commonly equated by exile Tibetans, from the Dalai Lama down
to illiterate farmers, with the Tibetan Buddhist ethics of altruism and compassion.
So how, exactly, is the potency of tradition – of Tibetan medicine, of traditional
quality control, of Tibetan Buddhist ethics, of Tibetanness itself – lost, as Tenzin
Thaye claims? And what kind of help can modernity provide?
Ironically, it is Tibetan medicine’s extraordinary growth and success during
the past decade that has rendered its traditional concepts and practices increas-
ingly impracticable today. There are, first of all, the direct pharmaceutical conse-
quences of Tibetan medicine’s recent entrance into the capitalist market, its rapid
economic development, and the attendant shift to pharmaceutical mass produc-
tion. Technical questions arise in the industrialization of any medicine: the neces-
sary compromises between in this case Buddhist scriptures and the factory floor
directly affect the end products’ potency (see Craig; Saxer; and Banerjee). What
is more, with the rapidly mounting need for raw materials to produce ever-grow-
ing quantities of medicines, traditional plant collecting in the mountains by the
doctors themselves has become insufficient, and, consequently, of less impor-
tance. In 2007–8, for example, Men-Tsee-Khang doctors and students only col-
lected 2.7 percent of the 52 tons of raw materials used during that year, with
another 8.2 percent donated mostly by Tibetan Buddhists from different Hima-
layan regions. The remaining 89 percent of the Men-Tsee-Khang’s raw materials
were procured from various other dealers and markets. This left the institute with
little knowledge and control over how, where, and when those materials were col-
lected, cleaned, dried, stored, and transported.
Although Tibetan doctors and medical institutions have always purchased or
bartered for a certain percentage of their raw materials from traders or villagers,
the unprecedented rise in the proportion of those purchases exposes them to capi-
talist market forces and constitutes a major change in the practice of Tibetan med-
icine. Dr. Tenzin Namdul from the Men-Tsee-Khang’s Clinical Research Depart-
ment explained the situation like this:

We are never saying that in our ancient medical texts there is no prop-
er way of ensuring the quality of the raw materials, or of standardizing
the finished pills. But we need to understand that with today’s global
changes, so many herbs are becoming endangered species. Even if they
are available, they tend to have far less efficacy than they used to have
earlier. Take amla [Indian gooseberry], for example, which is a wide-
ly used ingredient not only in Tibetan medicine but also in Ayurveda,
Unani, and Siddha. Now if I get it from Kangra this time, then next
time from Amritsar, and the third time from Delhi – the same ingredi-

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 (Im-)Potent Knowledges | 133

ent, we get it from three different places and agencies. We can’t be sure
about its potency, whether they have the same qualities, how they were
dried and stored… So to make sure that we maintain the quality, we
need to have tools to check whether they have the same potency. (April
19, 2008, Dharamsala)

Adding to this, Dr. Tenzin Thaye pointed out: “Nowadays it’s not like before. All
the plants, all the medical ingredients are changing […] not because of nature,
but because of the people who are selling them. If they want to make money, they
may mix other plants in, so one really has to be careful” (September 19, 2008,
Dharamsala).
In a nutshell, losing control over the first stages through which the raw
materials pass on their way to the market is nothing less than a loss of con-
trol over quality. It is difficult to utilize traditional monitoring methods to deter-
mine whether plants have been collected, cleaned, dried, and stored correctly,
or whether they have been polluted with pesticides or other chemicals. As trad-
ers struggle to satisfy the huge demand for raw materials created by the recent
boom in herbal medicines and products in India and abroad (whether under the
name of Tibetan medicine, Ayurveda, Unani, Siddha, or Traditional Chinese Med-
icine), it is almost inevitable that the quality of their herbs will be inferior to
those collected by amchi. Furthermore, the growing commercial exploitation of
wildcrafted plants also leads to an environmental degradation that affects the size,
quantity, and quality of herbs the amchi are able to collect, even if they do travel
to the mountains and gather the plants themselves.
As Tenzin Thaye mentioned, inferior quality of medical ingredients may also
be a direct result of the traders’ attempts to maximize their profits by unethical
means. Examples of such cheating include failing to properly dry and clean the
plants so that they weigh more, selling old or deteriorated plant material, and
adulterating or totally replacing expensive raw materials with cheaper ones. As
altruism and compassion are lost in the market place of greed and corruption,
the potency of Tibetan medicine suffers. Therefore, it is not that traditional qual-
ity control is inadequate today, but that it has become impossible to practice in
today’s market economy. The only solution to ensure a certain level of quality,
then, is the use of modern scientific methods, such as microscopic and chemical
analyses, with which adulterations, moisture levels, and pollution can be detected
and measured.
There is yet another problem with buying raw materials from the free mar-
ket. As traders source their herbs from different and often changing locations all
over South and Central Asia and even beyond, what is in question is not only the
quality of the raw materials but also their type, that is, their species. By their own
admission, many amchi acknowledge that traditional Tibetan plant taxonomy is
imprecise and often confusing, with different names given to the same species (as
defined by Western taxonomy) or different species conflated under one Tibetan

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134 | Stephan Kloos

name (see Shankar et al. 1501). As long as doctors who possessed generations
of experience collected the herbs locally this situation was not a problem. Nor is
it an issue with a large percentage of the raw materials bought on today’s mar-
ket, the bulk of which consists of common food spices like cloves or cardamom.
However, in the case of certain mountain herbs, dried barks and roots, or plant
material that has already been processed into powder form, Tibetan doctors find it
difficult to discern whether or not the raw materials they are getting are the ones
they actually want.
The amchi have found two solutions to deal with these dilemmas. One is to
cultivate plants that are more expensive, rare, or difficult to identify. This is an
attractive alternative because it is potentially cheaper, environmentally sustain-
able, avoids the mechanism of the capitalist market place, and thus helps the
amchi regain control over the most sensitive aspects of their herbal supplies.
Indeed, the Men-Tsee-Khang has purchased six acres of land near Darjeeling for
this purpose, and other individuals and organizations have also begun to cultivate
medicinal herbs, especially in Ladakh. The problem with this solution is that so
far it has not worked. While there have been some successes in cultivating plants
that are already easily available and identifiable, it is exceedingly difficult to cul-
tivate rare mountain herbs, and all attempts to do so have failed. The other, more
practical answer is to employ the help of modern science in the form of Linnaean
taxonomy, microscopic analysis, or chromatography. Still, in many cases this is
not as easy as it may sound: if done properly, even the seemingly simple task
of matching or translating Tibetan plant names into Western taxonomy can take
years of research (see Kletter/Kriechbaum, and Shankar et al.).

The Impotence of Science

Quality control involves more than ruling out pollution and botanical confusion,
however. Rather, its central concern is the standardization of medical efficacy,
something the Men-Tsee-Khang’s diabetes study demonstrated all too clearly.
Doctors, patients, and researchers all need to be sure that the medication pre-
scribed, ingested, or tested yesterday will have the same effect tomorrow. Yet,
while modern science can help in detecting various kinds of contamination in
raw materials or finished pills, the standardization of Tibetan medicine’s potency
reveals the limits of modern technologies as much as it shows their indispen-
sability. For all its technological sophistication and promises of making Tibetan
medicine and its efficacy visible, conventional, reductionist modern science is
unable to check, measure, or ensure the pharmaceutical potency of Tibetan for-
mulas and their ingredients – something that experienced amchi can easily do
by simply relying on their knowledge and the faculties of taste, smell, and other
senses. Modern quality control standards, however, restrict their focus to major
active ingredients, and thus ignore traditional collection protocols, processing

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 (Im-)Potent Knowledges | 135

techniques, storage, and shelf life, all of which are an essential part of Tibetan
standards (Shankar et al. 1504). Furthermore, biopharmaceutical tests are unable
to analyze the individual and synergetic effects of up to one hundred sixty differ-
ent herbal, mineral, metal, or animal ingredients contained in some Tibetan pills
(Harilal 50). Put another way, the potency and efficacy of Tibetan medicine is
beyond the grasp of science – immeasurable, invisible, irreducible to a particu-
lar chemical, molecule, or active ingredient. Even if it could be reduced to the
presence of certain chemicals, Tsewang Gyatso explained that for these materi-
als, “there are no established norms or standards that we can rely on to check if
the [chemical] values are in the normal range or not” (December 31, 2007, Dhar-
amsala).
Yet, it is clear that modern science is necessary in order to standardize poten-
cies and ensure the safety and quality of mass produced medicines. As the diabe-
tes study showed, it is difficult for amchi to compare and regulate potencies dia-
chronically. Moreover, with traditional methods alone, they are unable to establish
any reproducible standards of efficacy or any reliable system of documentation
acceptable under national or international drug regulations. Indeed, this is not
simply a problem for Tibetan medicine, but for most pharmaceutical-based sys-
tems of ‘traditional medicine’, leading the Indian scholar Darshan Shankar and
others to propose “intercultural quality standards” (Shankar et al.), which would
combine modern and traditional sciences without compromising the integrity and
standards of either. Exile Tibetan amchi have thus begun to implement modern
and traditional approaches to ensure and ‘preserve’ the quality of their medicines.
The idea is to first check the potency of an ingredient or finished pill by tradi-
tional means, and then (if acceptable) conduct a chemical analysis to establish the
values of its chemical composition. Over the years, by comparing the values of
different batches of the same ingredient or medicine with each other, it may be
possible to establish chemical norms that reflect and correspond to the amchi’s
expertise. In short, such intercultural quality standards, through the figures and
graphs of modern science, would make Tibetan pharmaceutical knowledge visi-
ble and legible.
No doubt, establishing such standards is complicated and labor intensive
work. Yet, since the establishment of a new quality control laboratory at the
Men-Tsee-Khang’s pharmaceutical unit in 2009, its two-person staff (trained in
microbiology) has not only tested samples of each batch of raw materials and fin-
ished pills for moisture levels, mold, and fungus, but has also begun compiling
chemical analyses in order to create and systematize such standards. Since most
of the one hundred seventy types of medicine used by the Men-Tsee-Khang are
only produced once a year (or even less frequently), in its fifth year this effort is
still in its beginning stages, and is mostly limited to documentation rather than a
transformation of pharmaceutical practice. As Dr. Tenzin Thaye told me,

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136 | Stephan Kloos

TT: Actually we work fully according to the tradition. But for documen-
tation, we also try to develop the other way, like scientific tests. For
example now, when we are drying the pills, our doctors check wheth-
er they are dry or not by chewing them – in the Buddhist way. But for
quite some time now, the scientists are testing them too. When we say,
“ok the pills are dry,” then they also test them, to collect some docu-
mentation. Sometimes, with some medicines that are very oily, it hap-
pens that we say they are dry, but when they check them, they say the
oil content or moisture is high.
SK: And then what happens? You say it’s dry, and they say it’s not
dry…
TT: They say that the moisture is a little high. But it may be because of
the nature of the plants. So they just note it down.
SK: And do you dry them more because of that?
TT: No, no. Actually, the doctors and people who work there are very
efficient, they have many years’ experience, chewing and testing the
pills… (June 24, 2008, Dharamsala)

In other words, for the most part, modern quality control at the Men-Tsee-Khang
serves, like the clinical trials, as an ‘ornament’ – producing stacks of paper docu-
menting (one could say, ‘decorating’) every step of the pharmaceutical production
process, making the Men-Tsee-Khang’s medicines more attractive to non-Tibet-
ans, instilling faith in skeptics. With the goal of securing legal recognition and
establishing an export market in mind, the Men-Tsee-Khang has been working
to implement Good Manufacturing Practices (GMP) in its pharmacy for several
years now. Given the high standards and size of its pharmacy on the one hand,
and the relative ease of meeting Indian GMPs (which were designed with India’s
own medical traditions in mind) on the other, the Men-Tsee-Khang’s production
facilities are already almost fully GMP-compliant. What is missing, however, are
proper documentation procedures. Indeed, as Tsewang Gyatso and Tenzin Nam-
dul told me on different occasions, it is exactly this consistent and comprehensive
documentation that remains the most difficult requirement for the amchi to meet
– partly because of the sheer amount of work and logistics required, and partly
because they do not see any value in such an undertaking beyond complying with
cumbersome legal regulations.
But despite Dr. Tenzin Thaye’s assurance that traditional methods are still
being followed, the influence of the knowledge generated through modern qual-
ity control procedures is growing, at times directly interfering with the production
process. For example, there have been occasions when whole batches of medi-
cines have been discarded based on the advice of the laboratory staff. Not sur-
prisingly, this gradual transfer of power away from traditionally trained, expe-
rienced amchi to young college graduates with degrees in natural sciences has
caused concerns among the older practitioners. Dr. Tsering Dorjee from the Mate-
ria Medica Department, for example, told me:

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 (Im-)Potent Knowledges | 137

I sometimes feel very doubtful about the scientific results. If we say,

“science is modern and therefore it has to be accepted” – I don’t think
so. It still needs experience too. And the basic, basic, basic thing is to
have a good heart. Also, sometimes people say that according to sci-
ence, something is the case. But on what kind of scientific basis do they
say that? Is the basis really firm and true, and were the experiments that
have been done in the past – if they have been done at all – really reli-
able? And how reliable will this knowledge remain in the future? Sci-
ence is changing all the time, knowledge is constantly upgrading. So we
cannot depend on scientific methods one hundred percent. Therefore, I
feel that whether in the case of raw materials or finished products, the
doctors should be the main ones in charge. Not the scientists, which
sadly is sometimes done here at the Men-Tsee-Khang. Personally, I do
not agree with this at all. Doctors who have a lot of experience should
control this. If they need some backup from the scientists, they can tell
them to do tests. And then they can combine these two knowledges, and
say what is ok and what is not. This should happen on the basis of a
good heart, a good motivation. (September 11, 2008, Dharamsala)

Dr. Tsering Dorjee was worried that the doctors’ traditional experience is being
increasingly subordinated to modern education. But even more than that, he had
apprehensions that Tibetan medicine’s Buddhist ethics – that is, its Tibetan iden-
tity, located in the doctors’ “good hearts” – was slowly being replaced by the cold
machines of modern science. Nevertheless, most people at the Men-Tsee-Khang
insisted that this was not a matter of replacement but of complementing. Modern
quality control technologies might make up for a lack of Buddhist ethics in the
case of Indian herb traders and business people, but no amount of documentation
or number of lab tests could replace Buddhist ethics among the Tibetan amchi.
To the amchi, Ayurveda provided a particularly illustrative negative example: far
more modernized than Tibetan medicine, it was seen as corrupt and consequently
of little medical use. Tsering Tashi, who would become the Men-Tsee-Khang’s
director in 2012, told me in 2009:

They have lots of scandals in Ayurvedic factories, you know. Despite all
their control systems: first they have to [issue] a tender for herb suppli-
ers, then they have scientists with all sorts of equipment to monitor the
quality, so many things! We have none of that. But somehow, dirt [gets]
into their medicine! [laughs] On the other hand, we are somehow able to
control that. (May 19, 2009, Evanston, IL)

Yet, Dr. Tsering Dorjee’s misgivings are valid, as the biggest threat to Tibetan
medicine and culture today is not seen in the Chinese state anymore, but in the
amchi’s moral decline brought about by temptations of the capitalist market.
Thus, an article in the English-language exile Tibetan magazine Tibetoday argues,
“Unfortunately, the Tibetan Sowarigpa that once survived the ideological holo-
caust of Mao’s China is now facing its toughest enemy and opponent both inside

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138 | Stephan Kloos

and outside Tibet. Physicians […] maintain that the ills of greed, neglect and the
commercialization of the Sowarigpa tradition in and outside Tibet would do more
harm in the long run when it comes to preserving the authenticity and the profes-
sional expertise of the Sowarigpa tradition” (Chukora 14). Indeed, if the amchi’s
motivation shifted from helping others to making a lot of money quickly, as was
– at least in the exile Tibetans’ perceptions – slowly but increasingly the case,
then Tibetan medicine was going down the same undesirable route Ayurveda had
taken some decades earlier. The results of this scenario were clear to all: Tibetan
medicine’s efficacy – and reputation – would diminish due to the amchi’s desire
to maximize their profits. This would not only threaten the long-term survival
of Tibetan medical knowledge, but also harm Tibetan culture and the Tibetan
nationalist cause. While modern quality control was unavoidable in a broader,
non-Buddhist context of capitalism and science, Buddhist ethics remained the
foundation of Tibetan medicine’s efficacy by ensuring virtuous behavior where
it mattered most, that is, among the amchi. Consequently, in recent years the
Men-Tsee-Khang has placed increasing importance on Buddhist ethics, trying to
instill in its students and amchi a sense of social responsibility that blends Bud-
dhist ethics with patriotism.
The limitations of modern science are, however, not confined to the arena of
preventing corruption and malpractice but extend to its core functions of measur-
ing, discovering, and making visible. As indispensable as modern quality control
has become in a context of pharmaceutical mass production, the capitalist mar-
ket, and national and international drug regulations, it cannot measure or con-
trol Tibetan medicine’s pharmaceutical potency. Dr. Tenzin Thaye’s idea of estab-
lishing modern scientific standards for Tibetan medicine’s efficacy is revealing
because it implies the reverse of his earlier statement. It may well be true that
modernity can help when the potency of tradition is lost, but this help is seriously
limited by modernity’s inability to understand this tradition. Ironically, modern
science is asked to prevent the loss of something it cannot grasp, and to make
visible what it cannot see. As a consequence, it requires the help of the tradition
it is supposed to assist in the first place. In a reversal of Tenzin Thaye’s quote,
it is thus also true that modernity, confronted with its own impotence, needs the
help of ‘tradition’. The amchi’s expert knowledge remains critical to any serious
effort to develop modern quality control that actually works for Tibetan medicine.

Conclusion: Fugitive No More

Volker Scheid, in his study Currents of Tradition in Chinese Medicine, argues

that ‘tradition’ is not a static entity but a process that has to change constantly in
order to continue. This resonates with the composite Tibetan term for ‘tradition’
or ‘traditional,’ srol gyun, where srol (tradition, system, custom, habitual practice,
habit) indicates tradition’s processual nature, and rgyun (continuity, stream, ever-

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 (Im-)Potent Knowledges | 139

lasting) indicates its continuity. It also resonates with the views of some of the
most prominent exile Tibetan intellectuals. On a rainy January day, Tenzin Tsun-
due, the well-known Tibetan poet-activist, told me:

These days, whatever someone does – play the flute, practice medicine,
whatever – they say it’s to preserve our culture. Of course, I am Tibet-
an too, and I understand that in our situation there’s a justified fear of
losing our culture. But what is Tibetan culture? Is it what we had in Ti-
bet before 1959? If you just preserve culture the way it was at a cer-
tain point in time, it becomes redundant. Then it’s not culture, it’s histo-
ry; it’s like something in a museum. Culture is alive, though, and there-
fore it has to change, you can’t prevent that. And not everything about
our culture, the way it was before the Chinese invaded us, was good. So
we have to evolve, keep what’s good and develop or change the rest. In
my opinion, this is the only way our culture – any culture – can survive.
(January 16, 2008, Dharamsala)

Without a doubt, Tibetan medicine has to move forward in order to survive and
remain relevant. And certainly it has advanced, from an unknown regional med-
ical tradition struggling to endure in the 1960s to today’s thriving alternative
health resource, which is rapidly expanding worldwide. Tibetan medicine’s singu-
lar state as a fugitive knowledge was key to its radical transformation and global
spread in the later part of the twentieth century. It was precisely the Tibetan ref-
ugees’ concern for cultural survival and the preservation of knowledge in exile
that mandated its engagement with modernity and acted as a catalyst for change.
As a result, Tibetan medicine has regained some of its old status as a hegemonic
knowledge in its own right. Fugitive no more, today it is not only emerging as
a multimillion dollar knowledge-industry, but also represents the intellectual and
cultural power of Tibet in Asia and the world.
This development, however, has ushered in a new range of problems, regarded
by exile Tibetans as new threats to Tibetan medicine’s survival. On their own,
Tibetan medicine’s knowledge, traditions, and pills are indeed losing potency in
the modern world of GMP regulations, capitalism, and mass production. Requir-
ing new tools, new technologies, and a fresh understanding of their own profes-
sional knowledge and expertise, practitioners have turned to modern science for
help. Yet, contrary to most clinical studies that have been conducted so far, mod-
ern pharmaceutical quality control goes beyond merely decorating Tibetan trad-
itions with the ornament of science. Rather, the amchi’s engagement with modern
science in the domain of quality control leaves both sides redefined and perhaps
– existing power inequities and frictions notwithstanding – even reinvigorated.
Today, modern technologies and science have become an existential condition for
the very core of Tibetan medicine’s identity, that is, its ethics and efficacy. It has
become impossible for contemporary amchi to ensure the safety, quality, and effi-
cacy of their medicines – and thus fulfill their ethical obligation of providing the

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140 | Stephan Kloos

best possible care to their patients – by traditional means alone. It is the result-
ing insertion of modern scientific concepts and methods into the very foundations
of Tibetan medical knowledge and practice that constitutes Tibetan medicine’s
‘silent revolution’. Yet, just as Tibetan medicine’s Buddhist ethics, epistemic
methods, and centuries of experience have come to depend on modern science
for their continued existence, they emerge as more important than ever before in
the effort to preserve not only the medical, but also the cultural and political effi-
cacy of Tibetan medicine and the Tibetan nation. As such, they are no longer ‘tra-
dition’, but constitute the product of Tibetan medicine’s efforts to preserve culture
and help the world: an alternative, uniquely Tibetan modernity.

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